Clinical Observation On Allogeneic Hemotopoietic Stem Cell Transplantation For Patients With Severe Aplastic Anemia

Objective:To evaluate the efficacy of allogeneic hemotopoietic stem cell transplantation (Allo-HSCT) for severe aplastic anemia(SAA).Methods:Six patients with SAA (4 were SAA-Ⅰ,2 were SAA-Ⅱ) received allo-HSCT of related donors. Conditioning regimen was fludarabine (Flu) cyclophosphamide (CTX) and rabbit against human antithymocyte globulin (ATG).Graft-versus-host-disease(GVHD)prophylaxis was a combination of cyclosporineA(CSA),short-range methotrexate (MTX) and mycophenolate mofetil (MMF). Microsatellite technology (STR-PCR) was employed to detect hematopoietic stem cells implantation rate.Results:All of six patients showed hematopoietic reconstruction after transplantation. The median time of neutrophils reached to 0.5 X 109/L and platelet reached to 20X 109/L in six patients were17.5 (12-26) days and 13.5 (10-15) days respectively. Six patients were detected 100% implantation at early stage by STR-PCR. One patient showed intestinal gradeⅡacute GVHD and one patient occurred skin grade I acute GVHD. Both of them improved after use of methylprednisolone. Widely skin chronic GVHD and pulmonary mixed infection occurred in one patient.One case presented invasive pulmonary aspergillosis and one occurred bacterial pneumonia. Both of them were cured after antifungal or antibiotic therapy.Three cases with oral ulcer, two cases with hemorrhagic cystitis and all of them improved after treatment. All the cases were followed up for 4-60 months (median time 28 months) of which five cases survived. One died of widely skin chronic GVHD and pulmonary mixed infection.Conclusion:Allogeneic hematopoietic stem cell transplantation is a reliable and effective therapy for patients with SAA..